1
|
Campbell M, McEvoy JW, Calpin G, Concannon F, Redfern S. Perspectives of Healthcare Professionals on Clinician-Patient Communication of Cardiovascular Disease Risk. J Patient Exp 2024; 11:23743735241257386. [PMID: 38807917 PMCID: PMC11131389 DOI: 10.1177/23743735241257386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
When the consultation is predominantly verbal, existing research in clinician-patient communication indicates that many patients struggle to understand and recall medical consultations or may not understand the extent of their illness or the purpose of their treatment plan. When the clinician-patient discussion centers around the risk of a repeated cardiovascular disease (CVD) related event, qualitatively assessing what factors affect the communication of this risk may guide the creation of effective communication solutions. Semi-structured interviews were conducted with 17 clinicians treating patients at stages along the cardiac rehabilitation patients' journey. Thematic analysis identified factors that prevent patients from understanding the risk they face of experiencing a repeated cardiac event. Results indicate a clearer understanding of the cardiac rehabilitation patient journey by means of a patient journey map; an overview of how CVD risk is currently communicated; and the factors that affect communication of these risks in the form of themes and sub-themes. Findings shape the proposal of an evidence informed model of opportunities for enhanced digital media supported communication in cardiac rehabilitation.
Collapse
|
2
|
Mathews J, Merchant S, Galica J, Palmer MJ, O'Donnell J, Koven R, Booth C, Brundage M. Measuring prognostic awareness in patients with advanced cancer: a scoping review and interpretive synthesis of the impact of hope. J Natl Cancer Inst 2024; 116:506-517. [PMID: 38134429 DOI: 10.1093/jnci/djad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Assessment of prognostic awareness (PA) in patients with advanced cancer is challenging because patient responses often indicate their hopes. The objectives of this scoping review were to summarize studies that measured PA in patients with advanced cancer and to synthesize data about how PA was measured and whether hope was incorporated into the measurement. METHODS MEDLINE and Embase databases were searched from inception to December 14, 2021. Data regarding the impact of hope on assessment of PA were extracted when studies reported on patients' beliefs about prognosis and patients' beliefs about their doctor's opinion about prognosis. An interpretive synthesis approach was used to analyze the data and to generate a theory regarding the incorporation of hope into the assessment of PA. RESULTS In total, 52 studies representing 23 766 patients were included. Most were conducted in high-income countries and measured PA based on the goal of treatment (curable vs incurable). Five studies incorporated hope into the assessment of PA and reported that among patients who responded that their treatment goal was a cure, an average of 30% also acknowledged that their doctors were treating them with palliative intent. Interpretive synthesis of the evidence generated a trinary conceptualization of PA patients who are aware and accepting of their prognosis; aware and not accepting; and truly unaware. Each of these groups will benefit from different types of interventions to support their evolving PA. CONCLUSION The trinary conceptualization of PA may promote understanding of the impact of hope in the assessment of PA and guide future research.
Collapse
Affiliation(s)
- Jean Mathews
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Shaila Merchant
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
- Division of General Surgery and Surgical Oncology, Queen's University, Kingston, ON, Canada
| | - Jacqueline Galica
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
- School of Nursing, Queen's University, Kingston, ON, Canada
| | - Michael J Palmer
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Jennifer O'Donnell
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Rachel Koven
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Christopher Booth
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Michael Brundage
- Department of Oncology, Queen's University, Kingston, ON, Canada
| |
Collapse
|
3
|
Yong FR, Naicker S, Uebel K, Agaliotis M, Chan C, Nguyen JDT, Pathirana T, Hawkey A, Vuong K. "We're trained to trust our patients": a qualitative study on the general practitioners' trust in patients for colorectal cancer shared care. Fam Pract 2023:cmad095. [PMID: 37797167 DOI: 10.1093/fampra/cmad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND In a therapeutic partnership, physicians rely on patients to describe their health conditions, join in shared decision-making, and engage with supported self-management activities. In shared care, the patient, primary care, and specialist services partner together using agreed processes and outputs for the patient to be placed at the centre of their care. However, few empirical studies have explored physicians' trust in patients and its implications for shared care models. AIM To explore trust in patients amongst general practitioners (GPs), and the impacts of trust on GPs' willingness to engage in new models of care, such as colorectal cancer shared care. METHODS GP participants were recruited through professional networks for semi-structured interviews. Transcripts were integrity checked, coded inductively, and themes developed iteratively. RESULTS Twenty-five interviews were analysed. Some GPs view trust as a responsibility of the physician and have a high propensity for trusting patients. For other GPs, trust in patients is developed over successive consultations based on patient characteristics such as honesty, reliability, and proactivity in self-care. GPs were more willing to engage in colorectal cancer shared care with patients with whom they have a developed, trusting relationship. CONCLUSIONS Trust plays a significant role in the patient's access to shared care. The implementation of shared care should consider the relational dynamics between the patient and health care providers.
Collapse
Affiliation(s)
- Faith R Yong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Safe and Effective Medication Research Collaborative, School of Pharmacy, Faculty of Health and Behavioural Science, University of Queensland, Brisbane, Australia
- Westmead Institute of Medical Research, University of Sydney, Westmead, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kerry Uebel
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Maria Agaliotis
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Rozelle, Australia
| | - Christopher Chan
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - John D T Nguyen
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | - Kylie Vuong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| |
Collapse
|
4
|
Cox C, Fritz Z. What is in the toolkit (and what are the tools)? How to approach the study of doctor-patient communication. Postgrad Med J 2023; 99:631-638. [PMID: 37319157 PMCID: PMC10464852 DOI: 10.1136/postgradmedj-2021-140663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
Doctor-patient communication is important, but is challenging to study, in part because it is multifaceted. Communication can be considered in terms of both the aspects of the communication itself, and its measurable effects. These effects are themselves varied: they can be proximal or distal, and can focus on subjective measures (how patients feel about communication), or objective measures (exploring more concrete health outcomes or behaviours). The wide range of methodologies available has resulted in a heterogeneous literature which can be difficult to compare and analyse. Here, we provide a conceptual approach to studying doctor-patient communication, examining both variables which can controlled and different outcomes which can be measured. We present methodologies which can be used (questionnaires, semistructured interviews, vignette studies, simulated patient studies and observations of real interactions), with particular emphasis on their respective logistical advantages/disadvantages and scientific merits/limitations. To study doctor-patient communication more effectively, two or more different study designs could be used in combination. We have provided a concise and practically relevant review of the methodologies available to study doctor-patient communication to give researchers an objective view of the toolkit available to them: both to understand current research, and to conduct robust and relevant studies in the future.
Collapse
Affiliation(s)
- Caitríona Cox
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Zoë Fritz
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| |
Collapse
|
5
|
Summers KM, Scherer A, Chasco EE, Ryan GL. Defining infertility: a qualitative interview study of patients and physicians. J Reprod Infant Psychol 2023:1-15. [PMID: 37288784 DOI: 10.1080/02646838.2023.2221277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate if infertility patients and physicians apply a traditional biomedical model of disease in their conceptualisation of infertility, examine any contradictions and conflicts in conceptualisations, and examine areas of concordance and discordance between physicians and patients. METHODS Semi-structured interviews were conducted with 20 infertility patients and 18 infertility physicians between September 2010 and April 2012. Interviews were analysed qualitatively to determine physician and patient conceptualisations of infertility, reactions to the definition of infertility as a disease, and potential benefits and concerns related to application of a disease label to the condition. RESULTS Most physicians (n = 14/18) and a minority of patients (n = 6/20) were supportive of defining infertility as a disease. Many of the patients who agreed with classifying infertility as a disease expressed that they had not personally defined it as such previously. Physicians (n = 14) and patients (n = 13) described potential benefits of a disease label, including increases in research funding, insurance coverage, and social acceptability. Some patients (n = 10) described potential stigma as a negative consequence. When describing appraisals of infertility, both physicians (n = 7) and patients (n = 8) invoked religious/spiritual concepts. The potential for religious/spiritual appraisal to contribute to stigmatising or de-stigmatising infertility was discussed. CONCLUSION Our findings contradict the assumption that infertility physicians and patients are fully supportive of defining infertility as a disease. While potential benefits of the disease label were recognised by both groups, caution against potential for stigmatisation and unsolicited invocation of religion/spirituality suggest a more holistic model may be appropriate.
Collapse
Affiliation(s)
- K M Summers
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - A Scherer
- Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - E E Chasco
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
| | - G L Ryan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Washington Medical Center Montlake, Seattle, WA, USA
| |
Collapse
|
6
|
Malbois E, Hurst-Majno S. Empathy is not so perfect! -For a descriptive and wide conception of empathy. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:85-97. [PMID: 36380157 PMCID: PMC9984513 DOI: 10.1007/s11019-022-10124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Physician empathy is considered essential for good clinical care. Empirical evidence shows that it correlates with better patient satisfaction, compliance, and clinical outcomes. These data have nevertheless been criticized because of a lack of consistency and reliability. In this paper, we claim that these issues partly stem from the widespread idealization of empathy: we mistakenly assume that physician empathy always contributes to good care. This has prevented us from agreeing on a definition of empathy, from understanding the effects of its different components and from exploring its limits. This is problematic because physicians' ignorance of the risks of empathy and of strategies to manage them can impact their work and wellbeing negatively. To address this problem, we explore the effects of the potential components of empathy and argue that it should be conceived as a purely descriptive and wide term. We end by discussing implications for medical education.
Collapse
Affiliation(s)
- Elodie Malbois
- Institute for Ethics, History, and the Humanities, University of Geneva, Geneva, Switzerland.
| | - S Hurst-Majno
- Institute for Ethics, History, and the Humanities, University of Geneva, Geneva, Switzerland
| |
Collapse
|
7
|
Villaruz LC, Socinski MA, Weiss J. Guidance for clinicians and patients with non-small cell lung cancer in the time of precision medicine. Front Oncol 2023; 13:1124167. [PMID: 37077826 PMCID: PMC10107372 DOI: 10.3389/fonc.2023.1124167] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
Major advances in the diagnosis and treatment of non-small cell lung cancer (NSCLC) have resulted in a sharp decline in associated mortality rates, thereby propelling NSCLC to the forefront of precision medicine. Current guidelines recommend upfront comprehensive molecular testing for all known and actionable driver alterations/biomarkers (EGFR, ALK, ROS1, BRAF, KRAS, NTRK, MET, RET, HER2 [ERBB2], and PD-L1), especially in advanced disease stages, as they significantly influence response to therapy. In particular, hybrid capture-based next-generation sequencing (HC-NGS) with an RNA fusion panel to detect gene fusions is a veritable requirement at both diagnosis and progression (resistance) of any-stage non-squamous adenocarcinoma NSCLCs. This testing modality ensures selection of the most timely, appropriate, and personalized treatment, maximization of therapeutic efficacy, and prevention of use of suboptimal/contraindicated therapy. As a complement to clinical testing and treatment, patient, family, and caregiver education is also key to early screening and diagnosis, access to care, coping strategies, positive outcomes, and survival. The advent of social media and increased internet access has amplified the volume of educational and support resources, consequently changing the dynamics of patient care. This review provides guidance on integration of comprehensive genomic testing with an RNA fusion panel as a global diagnostic standard for all adenocarcinoma NSCLC disease stages and provides key information on patient and caregiver education and resources.
Collapse
Affiliation(s)
- Liza C. Villaruz
- Hillman Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- *Correspondence: Liza C. Villaruz,
| | | | - Jared Weiss
- Division of Oncology, Lineberger Comprehensive Cancer at the University of North Carolina, Chapel Hill, NC, United States
| |
Collapse
|
8
|
Smallwood AJ, Neuner JM, Fletcher KE, Walker CM, Schapira MM. Patient-Physician Concordance for Quantitative Formats and Treatment Options and the Relationship with State Anxiety. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1684-1690. [PMID: 33904119 DOI: 10.1007/s13187-021-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Patient-physician concordance about topics discussed in a clinic visit is essential for effective communication but may be difficult to achieve in cancer care. We conducted a multicenter, observational study at two Midwestern oncology clinics. A sample of 48 English-speaking or Spanish-speaking women with newly diagnosed stage 0-3 breast cancer completed surveys before and after a visit with an oncologist. Patient-physician dyads were coded as concordant if both patient and physician follow-up self-reports agreed whether (or not) specific treatments were discussed (i.e., treatment option concordance; mastectomy, lumpectomy, hormone therapy, neoadjuvant, and adjuvant chemotherapy) and whether risk was described using certain quantitative formats (i.e., quantitative format concordance; percentages, proportions out of 100 and 1000, graphs, pictures, evidence from clinical studies, cancer stage). Agreement was determined using percent agreement and prevalence-adjusted bias-adjusted kappa (PABAK). Pearson's correlations were used to determine relationships between anxiety and each measure concordance. Percent concordance was higher for treatment concordance (73.3%) compared to quantitative format concordance (64.5%), and PABAK scores tended to be higher for treatment options (PABAK = .21-.78). Both treatment and quantitative format concordance were negatively associated with pre-visit state anxiety, but only treatment concordance was statistically significant (treatment: r = - .504, p = .001; quantitative format: r = - .096, p = .523). Our study indicates moderate patient-physician concordance in early breast cancer care communication and that patient anxiety may impact the ability for patients and physicians to agree on the content communicated in a clinic visit.
Collapse
Affiliation(s)
- Alicia J Smallwood
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Joan M Neuner
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Division of General Internal Medicine, Department of Medicine, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Kathlyn E Fletcher
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Clement J. Zablocki VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53295, USA
| | - Cindy M Walker
- School of Education, Office of the Dean, Duquesne University, 600 Forbes Ave, Pittsburgh, PA, 15282, USA
| | - Marilyn M Schapira
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA
| |
Collapse
|
9
|
Huepenbecker SP, Zhang X, Morgan MA, Haggerty AF. A prospective cross-sectional survey comparing patient and provider expectations regarding ovarian cancer prognosis. Gynecol Oncol Rep 2022; 42:101042. [PMID: 35874551 PMCID: PMC9303825 DOI: 10.1016/j.gore.2022.101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022] Open
Abstract
Providers believe prognostic discussions are important for ovarian cancer patients. Providers report having prognostic conversations more often than patients. Ovarian cancer patients and providers have different expectations surrounding treatment, remission, and survival. Age, marital status, religion, and cancer stage may affect patient perceptions of ovarian cancer prognosis.
Introduction There is limited data comparing patient and physician expectations regarding ovarian cancer prognosis. Our primary objective was to compare physician and patient estimates of survival to 6 months, 1 year, and 5 years; secondary objectives included comparing provider and patient responses on the likelihood of requiring future treatments and categorizing patient and provider preferences regarding communication about prognosis. Methods A prospective cross-sectional survey was delivered to 10 gynecologic oncology providers and 50 adult ovarian cancer patients from November 2015-April 2016 at one institution. Descriptive statistics were used to categorize survey answers and compare survey answers between patients and providers; multivariable logistic regression evaluated patient survey responses. Results All providers (100%) believed treating providers should discuss prognosis and 90% reported having prognostic conversations with patients, compared to 63%, 37%, and 4% of patients who reported discussing prognosis, living wills/advance directives, and palliative care/hospice services, respectively, with their provider. Compared to their provider, patients gave significantly lower estimations of requiring any future therapy (mean score 84.6 vs 74, p <.001) and future chemotherapy (mean score 84.1 vs 69.8, p <.001) and significantly higher estimations of requiring future surgery (mean score 23.3 vs 40, p <.001), achieving remission (mean score 33.5 vs 47.5, p =.009), survival to 1 year (mean score 77.1 vs 86.4, p =.002), and survival to 5 years (mean score 40.5 vs 61.3, p <.001). Conclusions Although gynecologic oncology providers believe it is important to discuss prognosis and end-of-life care, there are gaps in communication, knowledge, and expectations between providers and ovarian cancer patients.
Collapse
Affiliation(s)
- Sarah P. Huepenbecker
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
- Corresponding author.
| | - Xiaochen Zhang
- Center for Research on Reproduction and Women’s Health, University of Pennsylvania, 3440 Market St, Philadelphia, PA 19104, USA
| | - Mark A. Morgan
- Division of Gynecologic Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Ashley F. Haggerty
- Division of Gynecologic Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| |
Collapse
|
10
|
Poureslami I, FitzGerald JM, Tregobov N, Goldstein RS, Lougheed MD, Gupta S. Health literacy in asthma and chronic obstructive pulmonary disease (COPD) care: a narrative review and future directions. Respir Res 2022; 23:361. [PMID: 36529734 PMCID: PMC9760543 DOI: 10.1186/s12931-022-02290-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Respiratory self-care places considerable demands on patients with chronic airways disease (AD), as they must obtain, understand and apply information required to follow their complex treatment plans. If clinical and lifestyle information overwhelms patients' HL capacities, it reduces their ability to self-manage. This review outlines important societal, individual, and healthcare system factors that influence disease management and outcomes among patients with asthma and chronic obstructive pulmonary disease (COPD)-the two most common ADs. For this review, we undertook a comprehensive literature search, conducted reference list searches from prior HL-related publications, and added insights from international researchers and scientists with an interest in HL. We identified methodological limitations in currently available HL measurement tools in respiratory care. We also summarized the issues contributing to low HL and system-level cultural incompetency that continue to be under-recognized in AD management and contribute to suboptimal patient outcomes. Given that impaired HL is not commonly recognized as an important factor in AD care, we propose a three-level patient-centered model (strategies) designed to integrate HL considerations, with the goal of enabling health systems to enhance service delivery to meet the needs of all AD patients.
Collapse
Affiliation(s)
- Iraj Poureslami
- grid.417243.70000 0004 0384 4428Division of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 716-828 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada ,Canadian Multicultural Health Promotion Society (CMHPS), Vancouver, BC Canada
| | - J. Mark FitzGerald
- grid.417243.70000 0004 0384 4428Division of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 716-828 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Noah Tregobov
- grid.417243.70000 0004 0384 4428Division of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 716-828 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, Vancouver-Fraser Medical Program, University of British Columbia, Vancouver, BC Canada
| | - Roger S. Goldstein
- grid.17063.330000 0001 2157 2938Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,Respiratory Medicine, Westpark Healthcare Centre, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - M. Diane Lougheed
- grid.410356.50000 0004 1936 8331Asthma Research Unit, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON Canada ,grid.418647.80000 0000 8849 1617Institute for Clinical Evaluative Sciences, Toronto, ON Canada
| | - Samir Gupta
- grid.415502.7Unity Health, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON Canada
| |
Collapse
|
11
|
Vaitiekunas L, Coomer K, Turner C, Brown A, Sabesan S. Medical Oncology Care Plan: a tool for improving the provision of clinical information to patients. Intern Med J 2021; 51:1332-1335. [PMID: 34423549 DOI: 10.1111/imj.15449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
Improving clinical communication between patient and clinician through the provision of written information empowers patients to make informed decisions, underpinning patient-centred care and leading to greater health outcomes. The Townsville Cancer Centre has formulated a holistic care plan template for each patient as a tool to enhance this communication. Using questionnaire-based and qualitative surveys, understanding of the patient's cancer and perspectives of clinicians were examined. The results demonstrate that patients generally have a firm knowledge base of their disease with the predominant finding being that patients wish to be more informed with written information about their diagnosis and alternatives for treatment. While initially time consuming, completion of care plans had many benefits for clinicians; they prompted them to collect holistic information, engage in discussions to capture patient goals and document details about prognosis, treatment options and management of side-effects. Medical oncology care plans provide a sustainable method to provide clinicians a practical template to gather vital information and encourage patients to participate in the decision-making process for healthcare.
Collapse
Affiliation(s)
- Laurence Vaitiekunas
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Keegan Coomer
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Cassie Turner
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Amy Brown
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sabe Sabesan
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
12
|
van der Velden NCA, van der Kleij MBA, Lehmann V, Smets EMA, Stouthard JML, Henselmans I, Hillen MA. Communication about Prognosis during Patient-Initiated Second Opinion Consultations in Advanced Cancer Care: An Observational Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115694. [PMID: 34073341 PMCID: PMC8199300 DOI: 10.3390/ijerph18115694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022]
Abstract
Prognostic communication is essential for patients with advanced cancer to enable informed medical decision-making and end-of-life planning. Discussing prognosis is challenging, and might be especially complex for oncologists conducting a second opinion (SO). Survival data are often lacking, and consulting oncologists need to consider previously conveyed information and patients’ relationship with the referring oncologist. We qualitatively investigated how advanced cancer patients and consulting oncologists discuss prognosis during audio-recorded SO consultations (N = 60), including prognostic information received from the referring oncologist. Our results show that patients regularly expressed implicit cues to discuss prognosis or posed explicit questions tentatively. Consulting oncologists were mostly unresponsive to patients’ cues and cautious to prognosticate. They also seemed cautious when patients brought up the referring oncologist. Consulting oncologists checked which prognostic information patients had received from the referring oncologist, before estimating prognosis. They agreed with the first opinion or rectified discrepancies carefully. Altogether, this study exposes missed opportunities for open prognostic discussions in SOs. Consulting oncologists could explicitly explore patients’ information preferences and perceptions of prognosis. If desired, they can provide tailored, independent information to optimise patients’ prognostic awareness and informed medical decision-making. They may additionally support patients in dealing with prognosis and the uncertainties associated with it.
Collapse
Affiliation(s)
- N. C. A. van der Velden
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
- Correspondence:
| | - M. B. A. van der Kleij
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
| | - V. Lehmann
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - E. M. A. Smets
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - J. M. L. Stouthard
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
| | - I. Henselmans
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - M. A. Hillen
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
13
|
Lafaro KJ, Li A, Rodriguez J, Clark K, Loscalzo M, Wong FL, Melstrom LG, Warner SG. Surgeon and patient perceptions of cure in advanced gastrointestinal malignancies: Are we on the same page? J Surg Oncol 2020; 122:489-494. [PMID: 32441359 DOI: 10.1002/jso.25986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Effective communication is essential to complex shared decision making and is associated with improved recovery and pain control. However, patients and surgeons often have disparate expectations of treatment efficacy and perceptions of cure for advanced malignancies. This study measures correlation of patient and surgeon expectations with perceptions of cure. METHODS Our prospective study surveying surgeon-patient dyads before and after surgical consultation was performed for advanced abdominal malignancy between July and November 2017 at a single NCI designated cancer center using electronic questionnaires. RESULTS Patients and surgeons' own opinions regarding surgical candidacy (Q1), chance at cure (Q2), and life expectancy (Q3) did not measurably change from pre- to postvisit survey as evidenced by unchanged response concordance (patients Q1 P = .82; Q2 P = .81; and Q3 P = .53; surgeon responses Q1: P = .17; Q2: P = .32; and Q3: P = .50). Patient and surgeon perception of likelihood of cure and of estimated life expectancy remained discordant in pre- and postvisit surveys (Q2: P = .006 and Q3: P = .03). CONCLUSIONS These data highlight the stark differences between patient and surgeon perceptions of cure and prognosis of gastrointestinal cancers. These results prove that a larger scale study using this electronic questionnaire is feasible and important to better understand these differences and enhance shared decision making.
Collapse
Affiliation(s)
- Kelly J Lafaro
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Arthur Li
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Jenny Rodriguez
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Karen Clark
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - F Lennie Wong
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| |
Collapse
|
14
|
The Effect of Prognostic Communication on Patient Outcomes in Palliative Cancer Care: a Systematic Review. Curr Treat Options Oncol 2020; 21:40. [PMID: 32328821 PMCID: PMC7181418 DOI: 10.1007/s11864-020-00742-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND While prognostic information is considered important for treatment decision-making, physicians struggle to communicate prognosis to advanced cancer patients. This systematic review aimed to offer up-to-date, evidence-based guidance on prognostic communication in palliative oncology. METHODS PubMed and PsycInfo were searched until September 2019 for literature on the association between prognostic disclosure (strategies) and patient outcomes in palliative cancer care, and its moderators. Methodological quality was reported. RESULTS Eighteen studies were included. Concerning prognostic disclosure, results revealed a positive association with patients' prognostic awareness. Findings showed no or positive associations between prognostic disclosure and the physician-patient relationship or the discussion of care preferences. Evidence for an association with the documentation of care preferences or physical outcomes was lacking. Findings on the emotional consequences of prognostic disclosure were multifaceted. Concerning disclosure strategies, affective communication seemingly reduced patients' physiological arousal and improved perceived physician's support. Affective and explicit communication showed no or beneficial effects on patients' psychological well-being and satisfaction. Communicating multiple survival scenarios improved prognostic understanding. Physicians displaying expertise, positivity and collaboration fostered hope. Evidence on demographic, clinical and personality factors moderating the effect of prognostic communication was weak. CONCLUSION If preferred by patients, physicians could disclose prognosis using sensible strategies. The combination of explicit and affective communication, multiple survival scenarios and expert, positive, collaborative behaviour likely benefits most patients. Still, more evidence is needed, and tailoring communication to individual patients is warranted. IMPLICATIONS Future research should examine the effect of prognostic communication on psychological well-being over time and treatment decision-making, and focus on individualising care.
Collapse
|
15
|
Duma N, Idossa DW, Durani U, Frank RD, Paludo J, Westin G, Lou Y, Mansfield AS, Adjei AA, Go RS, Ailawadhi S. Influence of Sociodemographic Factors on Treatment Decisions in Non-Small-Cell Lung Cancer. Clin Lung Cancer 2019; 21:e115-e129. [PMID: 31570228 DOI: 10.1016/j.cllc.2019.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/17/2019] [Accepted: 08/24/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In stage IV non-small-cell lung cancer (NSCLC), survival has significantly improved. Despite such trends, it has been noted that patients frequently refuse treatment. Therefore, we explored the factors associated with treatment refusal in NSCLC. PATIENTS AND METHODS Utilizing the National Cancer Data Base (NCDB), we identified all stage IV NSCLC cases from 2004 to 2014. Patients who received cancer treatment outside of the reporting facility were excluded. Multivariable logistic regression models were used to determine associations with treatment refusal. RESULTS A total of 341,993 patients were identified; 5.4% of patients refused radiotherapy and 10.3% refused chemotherapy despite provider recommendations. The proportion of patients refusing radiotherapy and chemotherapy increased over time from 4.2% to 7.3% and 7.9% to 15%, respectively (P < .001). In multivariable analysis, men were less likely to refuse treatment compared to women (respectively, odds ratio = 0.80; 95% confidence interval, 0.76-0.84; P < .001; odds ratio = 0.82; 95% confidence interval, 0.80-0.85; P < .001, respectively). Factors associated with radiotherapy refusal included: Medicaid or Medicare as primary insurance, uninsured status, low household median income, and lower educational level. Regarding chemotherapy, uninsured patients, Medicaid patients, and patients with a high comorbidity index were more likely to refuse chemotherapy. Asians had lower rates of chemotherapy refusal relative to non-Hispanic whites. Non-Hispanic whites, Hispanics, and Asians had increasing chemotherapy refusal rates over time, while non-Hispanic blacks had less pronounced trends over time. CONCLUSION Socioeconomic factors rather than race/ethnicity appear to influence the refusal of cancer treatment in patients with stage IV NSCLC. Assessing socioeconomic challenges should be an essential part of patient evaluation when discussing treatment options.
Collapse
Affiliation(s)
- Narjust Duma
- University of Wisconsin Carbone Cancer Center, Madison, WI.
| | - Dame W Idossa
- Division of Hematology and Medical Oncology, University of California San Francisco, San Francisco, CA
| | | | - Ryan D Frank
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Yanyan Lou
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Alex A Adjei
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
16
|
Draper EJ, Hillen MA, Moors M, Ket JCF, van Laarhoven HWM, Henselmans I. Relationship between physicians' death anxiety and medical communication and decision-making: A systematic review. PATIENT EDUCATION AND COUNSELING 2019; 102:266-274. [PMID: 30293933 DOI: 10.1016/j.pec.2018.09.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/19/2018] [Accepted: 09/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine the relationship between physicians' death anxiety and medical communication and decision-making. It was hypothesized that physicians' death anxiety may lead to the avoidance of end-of-life conversations and a preference for life-prolonging treatments. METHODS PubMed and PsycInfo were systematically searched for empirical studies on the relation between physicians' death anxiety and medical communication and decision-making. RESULTS This review included five quantitative and two qualitative studies (N = 7). Over 38 relations between death anxiety and communication were investigated, five were in line with and one contradicted our hypothesis. Physicians' death anxiety seemes to make end-of-life communication more difficult. Over 40 relations between death anxiety and decision-making were investigated, three were in line with and two contradicted the hypothesis. Death anxiety seemes related to physicians' guilt or doubt after a patient's death. CONCLUSIONS There was insufficient evidence to confirm that death anxiety is related to more avoidant communication or decision-making. However, death anxiety does seem to make end-of-life communication and decision-making more difficult for physicians. PRACTICE IMPLICATIONS Education focused on death and dying and physicians' emotions in medical practice may improve the perceived ease with which physicians care for patients at the end of life.
Collapse
Affiliation(s)
- Emma J Draper
- Department of General Practice & Elderly Care Medicine, VU University Medical Center, VU University, Amsterdam, the Netherlands.
| | - Marij A Hillen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marleen Moors
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | | | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
17
|
Bessen S, Jain RH, Brooks WB, Mishra M. “Sharing in hopes and worries”—a qualitative analysis of the delivery of compassionate care in palliative care and oncology at end of life. Int J Qual Stud Health Well-being 2019. [PMID: 31204909 PMCID: PMC6598487 DOI: 10.1080/17482631.2019.1622355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To explore the methods through which physicians deliver compassionate care during end-of-life (EOL). Compassionate care provides benefits to patients and providers and is particularly important for patients with serious illnesses, yet its practice remains limited. We aim to qualitatively characterize methods utilized by physicians that facilitate the delivery of compassionate care at EOL. Methods: We conducted 13 semi-structured interviews with physicians from palliative care and medical oncology subspecialities at a rural academic medical centre in New Hampshire. Interviews were transcribed and analysed using a qualitative research design. Results: Participants described methods of compassionate care ranging from symptom control to less tangible, non-verbal methods. Primary barriers to the delivery of compassionate care were described as within the broader healthcare system and within the inherent emotional difficulty of EOL care. Physicians from both subspecialities emphasized the importance of successful inter-provider relationships. Conclusions: Methods for delivering compassionate care at EOL are wide ranging, but barriers on a systemic and individual level should be addressed to make its practice more widespread. This can be accomplished, in part, by the standardization of EOL conversations, training physicians how to have meaningful EOL conversations, and integration of such conversations into electronic medical records.
Collapse
Affiliation(s)
- Sarah Bessen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Raina H. Jain
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Manish Mishra
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| |
Collapse
|
18
|
Stacey CL, Pai M, Novisky MA, Radwany SM. Revisiting ‘awareness contexts’ in the 21st century hospital: How fragmented and specialized care shape patients' Awareness of Dying. Soc Sci Med 2019; 220:212-218. [DOI: 10.1016/j.socscimed.2018.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/28/2022]
|
19
|
Monga V, Maliske SM, Kaleem H, Mott SL, K D Zamba G, Milhem M. Discrepancy between treatment goals documentation by oncologists and their understanding among cancer patients under active treatment with chemotherapy. Eur J Cancer Care (Engl) 2018; 28:e12973. [PMID: 30511450 DOI: 10.1111/ecc.12973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 08/09/2018] [Accepted: 10/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE/BACKGROUND Discussion of treatment goals between oncologists and patients is challenging. Patients frequently misunderstand goals of therapy. There are several methods to document goals of chemotherapy, however, and are frequently not incorporated into patient charts. METHODS/DESIGN Cancer patients receiving their first cycle of chemotherapy were interviewed. Patients' recall of discussions with their oncologist regarding therapy intent was assessed and compared to documentation. An adjusted McNemar's test was utilised. A one-sample proportion test was used to evaluate whether the overall observed rate of discordance was significantly different from the proposed 33% rate; a rate posited as a threshold too high in the clinical sense. RESULTS Two hundred and seven eligible patients were interviewed. Oncologist identified treatment goals were not documented in 24.6% of cases and had to be excluded. There was not a significant difference in the directionality of discordance present. Inter-rater agreement between patient and oncologist was found to be adequate (κ = 0.64). The overall rate of discordance (17.29%) was found to be significantly less than the proposed acceptable level of 33% (p < 0.01). Upon univariable analysis, age, gender, marital and employment status were not found to be associated with discordance. CONCLUSIONS Discordance between treatment goals documentation and their understanding exists, indicating continued miscommunication between the patient and oncologist.
Collapse
Affiliation(s)
- Varun Monga
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Seth M Maliske
- Aspirus Wausau Hospital Regional Cancer Center, Wausau, Wisconsin
| | - Hassan Kaleem
- Division of Hematology and Oncology, Texas Tech University, Lubbock, Texas
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Gideon K D Zamba
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Mohammed Milhem
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa
| |
Collapse
|
20
|
Razai M. Truth-telling to a cancer patient about poor prognosis: A clinical case report in cross-cultural communication. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1477750918779303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ethical principles are not mere abstract concepts of academic interest. They have to be applied by care providers in the real world under complex, challenging and often perplexing conditions. This paper discusses, through the case of an ethnic minority patient with metastasis of bowel cancer, the ethical dilemma of truth-telling and withholding information about poor prognosis. It highlights the complexities of applying ethical principles in a different cultural milieu, reflecting on different ethical frameworks and justifications. The paper also discusses some of the wider implications of the practices, issues and controversies of truth-telling about prognosis in cross-cultural communication relevant to clinical practice.
Collapse
Affiliation(s)
- Mohammad Razai
- St George’s, University of London, London, United Kingdom
| |
Collapse
|
21
|
Miller LS, Shelby RA, Balmadrid MH, Yoon S, Baker JA, Wildermann L, Soo MS. Patient Anxiety Before and Immediately After Imaging-Guided Breast Biopsy Procedures: Impact of Radiologist-Patient Communication. J Am Coll Radiol 2018; 13:e62-e71. [PMID: 27814826 DOI: 10.1016/j.jacr.2016.09.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate patient anxiety and its association with perceived radiologist-patient communication in the setting of imaging-guided breast biopsy. METHODS After informed consent was obtained, 138 women recommended for imaging-guided breast procedures completed questionnaires immediately before and after biopsies, measuring state anxiety using the State-Trait Anxiety Inventory (range, 20-80). Before biopsies, women also completed questionnaires regarding their perceived communication with the radiologists recommending the procedures (modified Questionnaire on the Quality of Physician-Patient Interaction), demographic characteristics, and medical history; immediately after the biopsies, they completed a measure of perceived communication with the radiologists performing the biopsies. Experience levels (eg, attending radiologist, fellow) of the radiologists recommending and performing the biopsies were recorded. Data were analyzed using paired and independent t tests, one-way analysis of variance, Pearson's correlations, and multiple linear regression analyses. RESULTS Average prebiopsy anxiety was 44.5 ± 12.4 (range, 20-77) on a scale ranging from 20 to 80 points. Perceived communication with radiologists recommending biopsies averaged 52.4 ± 11.5 (range, 18-65). Better communication with radiologists recommending biopsies was significantly associated with lower levels of prebiopsy anxiety (r = -0.22, P = .01). After the biopsies, women's anxiety significantly decreased (paired t = -7.32, P < .001). Better communication with radiologists performing biopsies (mean, 57.8 ± 8.4; range, 32-65) was associated with lower postbiopsy anxiety after accounting for patients' baseline anxiety levels (β = -0.17, P = .04). White women reported higher prebiopsy and postbiopsy anxiety; nonwhite women reported poorer communication with recommending radiologists. CONCLUSIONS Patients' perceptions of better communication with radiologists were associated with lower levels of anxiety before and after biopsies. These results have implications for radiologist training and adherence to mammographic screening.
Collapse
Affiliation(s)
- Lauren S Miller
- Riverside Radiology and Interventional Associates, Columbus, Ohio
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Sora Yoon
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Jay A Baker
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Liz Wildermann
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mary Scott Soo
- Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| |
Collapse
|
22
|
Lee HR, Lim C, Yun HG, Kang SH, Kim DY. Making an informed decision of Korean cancer patients: the discrepancy between a patient's recall of information and the information needed for acquisition of radiotherapy informed consent. Support Care Cancer 2017; 26:297-303. [PMID: 28791486 DOI: 10.1007/s00520-017-3848-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To give informed consent, a patient needs to sufficiently understand the information provided by a physician to decide among treatment options. Although shared decision-making is becoming an important aspect of patient-centered care, little is known about decision-making by cancer patients in Korea. OBJECTIVES This study assessed Korean cancer patients' understanding of treatment goals and the need to obtain further information after a physician obtained informed consent for radiotherapy. METHODS In this prospective study, doctors and patients completed questionnaires independently after informed consent for radiotherapy had been obtained. The questionnaires for the doctors and patients were comprised of matched items regarding treatment aims and the need for further information. RESULTS The study enrolled 103 cancer patients scheduled for radiotherapy. The proportion of respondents who stated that the intent of treatment was to bring about a cure was 80.6% among the patients (83 of 103 patients) and 53.4% (55 of 103 patients) among the doctors (p = 0.000). The proportion of respondents who believed that the aim was prolongation of life was 16.5 and 1.9%, respectively (p = 0.000). Regarding the need for further information, 42.7% (44/103) of the patients did not want further information because they had faith in the physicians' medical expertise. CONCLUSION Many Korean cancer patients misunderstand the aims of treatment and half of participants do not want further information. Physicians should address whether specific interventions can solve these barriers so that Korean cancer patients can make truly autonomous treatment decisions.
Collapse
Affiliation(s)
- Hye Ran Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Chiyeon Lim
- Biostatistics of School of Medicine, Dongguk University, Seoul, South Korea
| | - Hyong Geun Yun
- Department of Radiation Oncology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea
| | - Seung Hee Kang
- Department of Radiation Oncology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Kunggi-do Ilsandonggu Dongguk-ro 27, Goyang, 10326, South Korea.
| |
Collapse
|
23
|
Shin DW, Cho J, Kim SY, Yang HK, Park K, Kweon SS, Koh DH, Nam HS, Park JH. Patients' and family caregivers' understanding of the cancer stage, treatment goal, and chance of cure: A study with patient-caregiver-physician triad. Psychooncology 2017; 27:106-113. [DOI: 10.1002/pon.4467] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 05/11/2017] [Accepted: 05/30/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine/Supportive Care Center; Samsung Medical Center; Seoul South Korea
| | - Juhee Cho
- Department of Health, Behavior, and Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology; Sungkyunkwan University; Seoul South Korea
| | - So Young Kim
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju South Korea
- Division of Cancer Policy and Management, National Cancer Center; National Cancer Control Institute; Goyang South Korea
| | - Hyung Kook Yang
- Division of Cancer Policy and Management, National Cancer Center; National Cancer Control Institute; Goyang South Korea
| | - Keeho Park
- Division of Cancer Policy and Management, National Cancer Center; National Cancer Control Institute; Goyang South Korea
| | - Sun-Seog Kweon
- Jeonnam Regional Cancer Center; Chonnam National University Hwasun Hospital; Hwansun South Korea
| | - Dai Ha Koh
- Department of Preventive Medicine; Chonbuk National University Medical School; Jeonju South Korea
| | - Hae-Sung Nam
- Cancer Control Division, Daejeon Regional Cancer Center; Chungnam National University Hospital; Daejeon South Korea
| | - Jong-Hyock Park
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju South Korea
- Division of Cancer Policy and Management, National Cancer Center; National Cancer Control Institute; Goyang South Korea
| |
Collapse
|
24
|
Vallone S, Beunders I, Szmytke E. Lung cancer patient needs in different countries. Lung Cancer Manag 2017; 6:1-4. [DOI: 10.2217/lmt-2017-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/20/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | - Ewelina Szmytke
- Association For The Fight Against Lung Cancer in Poland, Gdansk, Poland
- Lung Cancer Europe (LuCE), Bern, Switzerland
| |
Collapse
|
25
|
Leppin AL, Kunneman M, Hathaway J, Fernandez C, Montori VM, Tilburt JC. Getting on the same page: Communication, patient involvement and shared understanding of "decisions" in oncology. Health Expect 2017. [PMID: 28636280 PMCID: PMC5750732 DOI: 10.1111/hex.12592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Patients and clinicians do not often agree on whether a decision has been made about cancer care. This could be explained by factors related to communication quality and/or the type of decision being made. Methods We used a self‐developed coding scheme to code a random sample of 128 encounters in which patients and clinicians either agreed (n=64) or disagreed (n=64) that a cancer care decision was made and tested for associations between concordance and key communication behaviours. We also identified and characterized cancer care decisions by topic and level of patient involvement and looked for trends. Results We identified 378 cancer care decisions across 128 encounters. Explicit decisions were most commonly made about topics wherein decision control could be easily delegated to a clear and present expert (eg either the patient or the clinician). Related to this, level of patient involvement varied significantly by decision topic. Explicit decisions were rarely made in an observable way about social, non‐clinical or self‐management related topics, although patients and clinicians both reported having made a cancer care decision in encounters where no decisions were observed. We found no association between communication behaviours and concordance in our sample. Conclusions What counts as a “decision” in cancer care may be constructed within disparate social roles that leave many agendas unaddressed and decisions unmade. Changing the content of conversations to encourage explicit decisions about self‐management and life context‐related topics may have greater value in enabling shared understanding than promoting communication behaviours among already high‐performing communicators.
Collapse
Affiliation(s)
- Aaron L Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,Division of Health Care and Policy Research, Mayo Clinic, Rochester, MN, USA
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Cara Fernandez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Jon C Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
26
|
Chen CH, Kuo SC, Tang ST. Current status of accurate prognostic awareness in advanced/terminally ill cancer patients: Systematic review and meta-regression analysis. Palliat Med 2017; 31:406-418. [PMID: 27492160 DOI: 10.1177/0269216316663976] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No systematic meta-analysis is available on the prevalence of cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received. AIM To examine the prevalence of advanced/terminal cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO were systematically searched on accurate prognostic awareness in adult patients with advanced/terminal cancer (1990-2014). Pooled prevalences were calculated for accurate prognostic awareness by a random-effects model. Differences in weighted estimates of accurate prognostic awareness were compared by meta-regression. RESULTS In total, 34 articles were retrieved for systematic review and meta-analysis. At best, only about half of advanced/terminal cancer patients accurately understood their prognosis (49.1%; 95% confidence interval: 42.7%-55.5%; range: 5.4%-85.7%). Accurate prognostic awareness was independent of service received and publication year, but highest in Australia, followed by East Asia, North America, and southern Europe and the United Kingdom (67.7%, 60.7%, 52.8%, and 36.0%, respectively; p = 0.019). Accurate prognostic awareness was higher by clinician assessment than by patient report (63.2% vs 44.5%, p < 0.001). CONCLUSION Less than half of advanced/terminal cancer patients accurately understood their prognosis, with significant variations by region and assessment method. Healthcare professionals should thoroughly assess advanced/terminal cancer patients' preferences for prognostic information and engage them in prognostic discussion early in the cancer trajectory, thus facilitating their accurate prognostic awareness and the quality of end-of-life care decision-making.
Collapse
Affiliation(s)
- Chen Hsiu Chen
- 1 Department of Nursing, University of Kang Ning, Tainan, Taiwan.,2 Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan
| | - Su Ching Kuo
- 2 Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan.,3 Department of Nursing, Yuanpei University, Hsinchu, Taiwan
| | - Siew Tzuh Tang
- 4 School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,5 Department of Nursing, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,6 Division of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan
| |
Collapse
|
27
|
Kris MG, Gaspar LE, Chaft JE, Kennedy EB, Azzoli CG, Ellis PM, Lin SH, Pass HI, Seth R, Shepherd FA, Spigel DR, Strawn JR, Ung YC, Weyant M. Adjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non-Small-Cell Lung Cancers: American Society of Clinical Oncology/Cancer Care Ontario Clinical Practice Guideline Update. J Clin Oncol 2017; 35:2960-2974. [PMID: 28437162 DOI: 10.1200/jco.2017.72.4401] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose The panel updated the American Society of Clinical Oncology (ASCO) adjuvant therapy guideline for resected non-small-cell lung cancers. Methods ASCO convened an update panel and conducted a systematic review of the literature, investigating adjuvant therapy in resected non-small-cell lung cancers. Results The updated evidence base covered questions related to adjuvant systemic therapy and included a systematic review conducted by Cancer Care Ontario current to January 2016. A recent American Society for Radiation Oncology guideline and systematic review, previously endorsed by ASCO, was used as the basis for recommendations for adjuvant radiation therapy. An update of these systematic reviews and a search for studies related to radiation therapy found no additional randomized controlled trials. Recommendations Adjuvant cisplatin-based chemotherapy is recommended for routine use in patients with stage IIA, IIB, or IIIA disease who have undergone complete surgical resections. For individuals with stage IB, adjuvant cisplatin-based chemotherapy is not recommended for routine use. However, a postoperative multimodality evaluation, including a consultation with a medical oncologist, is recommended to assess benefits and risks of adjuvant chemotherapy for each patient. The guideline provides information on factors other than stage to consider when making a recommendation for adjuvant chemotherapy, including tumor size, histopathologic features, and genetic alterations. Adjuvant chemotherapy is not recommended for patients with stage IA disease. Adjuvant radiation therapy is not recommended for patients with resected stage I or II disease. In patients with stage IIIA N2 disease, adjuvant radiation therapy is not recommended for routine use. However, a postoperative multimodality evaluation, including a consultation with a radiation oncologist, is recommended to assess benefits and risks of adjuvant radiation therapy for each patient with N2 disease. Additional information is available at www.asco.org/lung-cancer-guidelines and www.asco.org/guidelineswiki .
Collapse
Affiliation(s)
- Mark G Kris
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Laurie E Gaspar
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Jamie E Chaft
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Erin B Kennedy
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Christopher G Azzoli
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Peter M Ellis
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Steven H Lin
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Harvey I Pass
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Rahul Seth
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - David R Spigel
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - John R Strawn
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Yee C Ung
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Michael Weyant
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Faller H, Strahl A, Richard M, Niehues C, Meng K. The prospective relationship between satisfaction with information and symptoms of depression and anxiety in breast cancer: A structural equation modeling analysis. Psychooncology 2017; 26:1741-1748. [PMID: 28024096 DOI: 10.1002/pon.4358] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/15/2016] [Accepted: 12/22/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Previous research has demonstrated associations between satisfaction with information and reduced emotional distress in cancer patients. However, as most studies were cross-sectional, the direction of this relationship remained unclear. We therefore aimed to test whether information satisfaction predicted subsequent depression and anxiety levels, and, reciprocally, depression and anxiety levels predicted subsequent information satisfaction, thus clarifying the direction of impact. METHODS We performed a secondary analysis of a prospective cohort study with 436 female breast cancer patients (mean age 51 years). We measured information satisfaction with 2 self-developed items, symptoms of depression with the 2-item Patient Heath Questionnaire and symptoms of anxiety with the 2-item Generalized Anxiety Disorder Scale. We created 2 structural equation models, 1 for depression and 1 for anxiety, that examined the prediction of 1-year depression (or anxiety) levels by baseline information satisfaction and, in the same model, 1-year information satisfaction by baseline depression (or anxiety) levels (cross-lagged panel analysis). RESULTS Baseline information satisfaction predicted 1-year levels of both depression (beta = -0.17, P < .01) and anxiety (beta = -0.13, P < .01), adjusting for the baseline scores of the outcome variables. Conversely, baseline levels of depression (beta = -0.12, P < .05) and anxiety (beta = -0.16, P < .01) predicted 1-year information satisfaction, adjusting for its baseline score. CONCLUSION Our results suggest a bidirectional relationship between information satisfaction and symptoms of depression and anxiety. Thus, provision of information may reduce subsequent depression and anxiety, while reducing depression and anxiety levels may increase satisfaction with received information. Combining the provision of information with emotional support may be particularly beneficial.
Collapse
Affiliation(s)
- Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - André Strahl
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Matthias Richard
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christiane Niehues
- Reha-Zentrum Ückeritz, Klinik Ostseeblick, Ückeritz, Germany`.,Deutsche Rentenversicherung Bund, Berlin, Germany
| | - Karin Meng
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| |
Collapse
|
29
|
Family discussions on life-sustaining interventions in neurocritical care. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:397-408. [PMID: 28187812 DOI: 10.1016/b978-0-444-63600-3.00022-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Approximately 20% of all deaths in the USA occur in the intensive care unit (ICU) and the majority of ICU deaths involves decision of de-escalation of life-sustaining interventions. Life-sustaining interventions may include intubation and mechanical ventilation, artificial nutrition and hydration, antibiotic treatment, brain surgery, or vasoactive support. Decision making about goals of care can be defined as an end-of-life communication and the decision-making process between a clinician and a patient (or a surrogate decision maker if the patient is incapable) in an institutional setting to establish a plan of care. This process includes deciding whether to use life-sustaining treatments. Therefore, family discussion is a critical element in the decision-making process throughout the patient's stay in the neurocritical care unit. A large part of care in the neurosciences intensive care unit is discussion of proportionality of care. This chapter provides a stepwise approach to hold these conferences and discusses ways to do it effectively.
Collapse
|
30
|
Huebner J, Keinki C, Kleeberg J, Seilacher E. Communication before Cancer Surgery - the Perspective of Patients with Gastrointestinal Cancer. Oncol Res Treat 2016; 39:724-727. [PMID: 27855378 DOI: 10.1159/000450985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/05/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Jutta Huebner
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Frankfurt/M., Germany
| | | | | | | |
Collapse
|
31
|
Winner M, Wilson A, Yahanda A, Kim Y, Pawlik TM. A cross-sectional study of patient and provider perception of "cure" as a goal of cancer surgery. J Surg Oncol 2016; 114:677-683. [PMID: 27696412 DOI: 10.1002/jso.24401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with advanced cancer often misperceive the purpose and likely effectiveness of cancer treatments. The aim of this study was to characterize patient and provider perceptions in the setting of surgery for potentially curable cancer. METHODS One hundred and six patient-surgeon dyads were surveyed about their expectations for upcoming surgery. Items scored using a Likert scale were compared using the Wilcoxon signed-rank test. RESULTS Patients and surgeons reported excellent communication and shared decision-making. Patients more often than surgeons perceived that surgery was "Likely" or "Very Likely" to cure their cancer (86.0% vs. 72.0%, P = 0.011), extend their lives (94.0% vs. 82.0%, P = 0.007), and relieve cancer-related symptoms (65.0% vs. 35.0%, P < 0.001). Patients less often felt that surgery would be associated with complications (33.0% vs. 48.0%, P = 0.016). Over half (53.9%) of patients believed that they were more likely to experience surgical cancer cure compared with someone else with the same diagnosis while 70.8% of surgeons declared a patient's relative chances of surgical cure "the same." CONCLUSIONS Patients with resectable lung and gastrointestinal cancers have more optimistic perceptions about the outcomes of an upcoming surgery than their surgeons, even in a setting of good communication and shared decision-making. J. Surg. Oncol. 2016;114:677-683. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Megan Winner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ana Wilson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Yahanda
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yuhree Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
32
|
Pieterse AH, Kunneman M, Engelhardt EG, Brouwer NJ, Kroep JR, Marijnen CAM, Stiggelbout AM, Smets EMA. Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision-making perspective. Psychooncology 2016; 26:943-950. [PMID: 27502561 DOI: 10.1002/pon.4241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/17/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the occurrence of questions that foster shared decision making, in particular cancer patients' understanding of treatment decisions and oncologists' understanding of patients' priorities, during consultations in which preference-sensitive decisions are discussed. Specifically, (a) regarding patient understanding, do oncologists ask about patients' preexisting knowledge, information preferences, and understanding and do patients and companions ask about the disease and treatment, and (b) regarding patient priorities, do oncologists ask about patients' treatment- and decision-related preferences and do patients and companions ask about the decision? METHODS Audiotaped pretreatment consultations of 100 cancer patients with 32 oncologists about (neo)adjuvant treatment were coded and analyzed to document question type, topic, and initiative. RESULTS The oncologists ascertained prior knowledge in 50 patients, asked 24 patients about preferred (probability) information, and invited questions from 56 patients. The oncologists asked 32 patients about treatment preferences and/or for consent. Respectively, one-third and one-fifth of patients and companions asked about treatment benefits compared with three-quarters of them who asked about treatment harms and/or procedures. CONCLUSIONS It would be helpful to patients if oncologists more often assessed patients' existing knowledge to tailor their information provision. Also, patients could receive treatment recommendations that better fit their personal situation if oncologists collected information on patients' views about treatments. Moreover, by educating patients to ask about treatment alternatives, benefits, and harms, patients may gain a better understanding of the choice they have.
Collapse
Affiliation(s)
- A H Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kunneman
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.,Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - E G Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - N J Brouwer
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - C A M Marijnen
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
33
|
Clarke JN, Fletcher P. Communication Issues Faced by Parents Who have a Child Diagnosed with Cancer. J Pediatr Oncol Nurs 2016; 20:175-91. [PMID: 14567565 DOI: 10.1177/1043454203254040] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Twenty-nine parents of children who had been diagnosed with various cancers were interviewed through long, semistructured interviews conducted via telephone by a mother whose daughter once had cancer. Parents usually began their narratives of the defining moments in the months, weeks, or days prior to the diagnosis. The authors report on parents' views about one of the defining moments in the stories. At the first level, we call this “communication issues” and include the following topics: communication at diagnosis, contradictions and confusion, getting the “right” amount of information, good and poor communication, feeling listened to, and errors in medical information. At another level, the way that parents talk about communications issues reflects an underlying paradox that parents whose children have cancer face: They are and feel responsible for their children, and yet they often lack knowledge, authority, and power in their dealings with the health care system and its medical care providers.
Collapse
Affiliation(s)
- Juanne N Clarke
- Department of Sociology and Anthropology, Wilfrid Laurier University, Waterloo, ON, Canada.
| | | |
Collapse
|
34
|
Wallner LP, Hawley ST. Communicating Disease-Specific Knowledge to Patients: An Overlooked Aspect of Personalized Medicine. J Oncol Pract 2016; 12:497-8. [PMID: 27165486 DOI: 10.1200/jop.2016.012237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lauren P. Wallner
- University of Michigan; and Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| | - Sarah T. Hawley
- University of Michigan; and Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| |
Collapse
|
35
|
Rodenbach RA, Rodenbach KE, Tejani MA, Epstein RM. Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality. PATIENT EDUCATION AND COUNSELING 2016; 99:356-363. [PMID: 26519993 PMCID: PMC5955702 DOI: 10.1016/j.pec.2015.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/01/2015] [Accepted: 10/12/2015] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them. METHODS Qualitative interviews with physicians (n=25), nurse practitioners (n=7), and physician assistants (n=1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality. RESULTS Clinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was "conditional," meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients. CONCLUSION An awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care. PRACTICE IMPLICATIONS Efforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients.
Collapse
Affiliation(s)
- Rachel A Rodenbach
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA.
| | - Kyle E Rodenbach
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Mohamedtaki A Tejani
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, USA
| |
Collapse
|
36
|
Gironés R. Desire for Information in the Elderly: Interactions with Patients, Family, and Physicians. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:766-773. [PMID: 25428838 DOI: 10.1007/s13187-014-0760-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lung cancer chemotherapy decisions in patients≥70 years old are complex. To assess the modes of communication with older lung cancer patients, we prospectively collected data. We assessed patients' level of knowledge about diagnosis and prognosis. Eighty-three patients diagnosed with lung cancer from January 2006 to February 2008 were recruited from a single center. Logistic regression and multiple imputation methods were used to assess associations between patient information and independent variables. Families received the diagnosis of lung cancer (92.8%). Family was more protective when the patients were elderly (p 0.036), depressed (p 0.054), had dementia (p 0.03), had poor performance status (p 0.03), or complied with frailty criteria (p 0.014). Physicians who gave cancer diagnoses were not oncologists and they usually gave cancer diagnosis preferably to family members. Only 27.7% of patients were informed that they had tumors. A 73.5% of patients actively solicited information; however, elderly and frail patients tended to do so less. A large proportion of elderly lung cancer patients do not receive adequate information about their disease prior to contact with oncologists. However, they do actively ask for information and speak about cancer with oncologists.
Collapse
Affiliation(s)
- Regina Gironés
- Oncologist, Physician, Medical Oncology Unit, Hospital Lluís Alcanyís, Crta Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain.
| |
Collapse
|
37
|
Gorini A, Mazzocco K, Pravettoni G. Decision-Making Process Related to Participation in Phase I Clinical Trials: A Nonsystematic Review of the Existing Evidence. Public Health Genomics 2015; 18:359-65. [PMID: 26529420 DOI: 10.1159/000441559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Due to the lack of other treatment options, patient candidates for participation in phase I clinical trials are considered the most vulnerable, and many ethical concerns have emerged regarding the informed consent process used in the experimental design of such trials. Starting with these considerations, this nonsystematic review is aimed at analyzing the decision-making processes underlying patients' decision about whether to participate (or not) in phase I trials in order to clarify the cognitive and emotional aspects most strongly implicated in this decision. Considering that there is no uniform decision calculus and that many different variables other than the patient-physician relationship (including demographic, clinical, and personal characteristics) may influence patients' preferences for and processing of information, we conclude that patients' informed decision-making can be facilitated by creating a rigorously developed, calibrated, and validated computer tool modeled on each single patient's knowledge, values, and emotional and cognitive decisional skills. Such a tool will also help oncologists to provide tailored medical information that is useful to improve the shared decision-making process, thereby possibly increasing patient participation in clinical trials.
Collapse
Affiliation(s)
- Alessandra Gorini
- Department of Health Science, University of Milan, and European Institute of Oncology, Milan, Italy
| | | | | |
Collapse
|
38
|
Enzinger AC, Zhang B, Schrag D, Prigerson HG. Outcomes of Prognostic Disclosure: Associations With Prognostic Understanding, Distress, and Relationship With Physician Among Patients With Advanced Cancer. J Clin Oncol 2015; 33:3809-16. [PMID: 26438121 DOI: 10.1200/jco.2015.61.9239] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine how prognostic conversations influence perceptions of life expectancy (LE), distress, and the patient-physician relationship among patients with advanced cancer. PATIENTS AND METHODS This was a multicenter observational study of 590 patients with metastatic solid malignancies with progressive disease after ≥ one line of palliative chemotherapy, undergoing follow-up to death. At baseline, patients were asked whether their oncologist had disclosed an estimate of prognosis. Patients also estimated their own LE and completed assessments of the patient-physician relationship, distress, advance directives, and end-of-life care preferences. RESULTS Among this cohort of 590 patients with advanced cancer (median survival, 5.4 months), 71% wanted to be told their LE, but only 17.6% recalled a prognostic disclosure by their physician. Among the 299 (51%) of 590 patients willing to estimate their LE, those who recalled prognostic disclosure offered more realistic estimates as compared with patients who did not (median, 12 months; interquartile range, 6 to 36 months v 48 months; interquartile range, 12 to 180 months; P < .001), and their estimates were less likely to differ from their actual survival by > 2 (30.2% v 49.2%; odds ratio [OR], 0.45; 95% CI, 0.14 to 0.82) or 5 years (9.5% v 35.5%; OR, 0.19; 95% CI, 0.08 to 0.47). In adjusted analyses, recall of prognostic disclosure was associated with a 17.2-month decrease (95% CI, 6.2 to 28.2 months) in patients' LE self-estimates. Longer LE self-estimates were associated with lower likelihood of do-not-resuscitate order (adjusted OR, 0.439; 95% CI, 0.296 to 0.630 per 12-month increase in estimate) and preference for life-prolonging over comfort-oriented care (adjusted OR, 1.493; 95% CI, 1.091 to 1.939). Prognostic disclosure was not associated with worse patient-physician relationship ratings, sadness, or anxiety in adjusted analyses. CONCLUSION Prognostic disclosures are associated with more realistic patient expectations of LE, without decrements to their emotional well-being or the patient-physician relationship.
Collapse
Affiliation(s)
- Andrea C Enzinger
- Andrea C. Enzinger and Deborah Schrag, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Baohui Zhang and Holly G. Prigerson, Weill Cornell Medical College, New York, NY
| | - Baohui Zhang
- Andrea C. Enzinger and Deborah Schrag, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Baohui Zhang and Holly G. Prigerson, Weill Cornell Medical College, New York, NY
| | - Deborah Schrag
- Andrea C. Enzinger and Deborah Schrag, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Baohui Zhang and Holly G. Prigerson, Weill Cornell Medical College, New York, NY
| | - Holly G Prigerson
- Andrea C. Enzinger and Deborah Schrag, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Baohui Zhang and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
| |
Collapse
|
39
|
Johnson M, Tod AM, Brummell S, Collins K. Prognostic communication in cancer: A critical interpretive synthesis of the literature. Eur J Oncol Nurs 2015; 19:554-67. [DOI: 10.1016/j.ejon.2015.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/28/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
|
40
|
McIntyre R, Craig A. A Literature Review of Patient Education: Is IT Time to Move Forward? J Med Imaging Radiat Sci 2015; 46:S75-S85. [DOI: 10.1016/j.jmir.2015.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/17/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
|
41
|
Abstract
BACKGROUND Patient-physician communication is critical for helping patients understand and complete the complex steps needed to diagnose stage and treat lung cancer. We assessed which domains of patient-physician communication about lung cancer and its treatment are associated with receipt of disease-directed, stage-appropriate treatment. METHODS Patients with recently diagnosed lung cancer were recruited from four medical centers in New York City from 2008 to 2011. Participants were surveyed about discussions with physicians regarding treatment, symptoms, and needs. Multiple regression analysis and structural equation modeling were used to assess which communication factors were associated with disease treatment. RESULTS Of the 352 participants, 191 (54%) received disease-directed, stage-appropriate treatment. Unadjusted associations between communication items and treatment found that participants who felt that their physicians explained the risks and disadvantages of lung cancer treatment (p < 0.01), discussed their chances of cure (p = 0.02), discussed goals of treatment (p < 0.01), or who were warm and friendly (p = 0.04) were more likely to undergo treatment. Three communication domains were identified: treatment information, physician support, and patient symptoms/needs. After adjusting for known determinants of lung cancer treatment, increased treatment information was associated with higher probability of cancer-directed treatment (p = 0.003). Other communication domains (physician support or patient symptoms/needs) were not independent predictors of treatment (p > 0.05 for both comparisons). CONCLUSION These data suggest that treatment information is particularly important for increasing the probability of cancer-directed therapy among lung cancer patients. Clinicians should ensure that they clearly discuss treatment goals and options with patients while maintaining empathy, supporting patient needs, and addressing symptoms.
Collapse
|
42
|
Satisfaction with information and unmet information needs in men and women with cancer. J Cancer Surviv 2015; 10:62-70. [DOI: 10.1007/s11764-015-0451-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/08/2015] [Indexed: 11/12/2022]
|
43
|
Bourquin C, Stiefel F, Mast MS, Bonvin R, Berney A. Well, you have hepatic metastases: Use of technical language by medical students in simulated patient interviews. PATIENT EDUCATION AND COUNSELING 2015; 98:323-30. [PMID: 25535013 DOI: 10.1016/j.pec.2014.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 10/21/2014] [Accepted: 11/13/2014] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This research explored medical students' use and perception of technical language in a practical training setting to enhance skills in breaking bad news in oncology. METHODS Terms potentially confusing to laypeople were selected from 108 videotaped interviews conducted in an undergraduate Communication Skills Training. A subset of these terms was included in a questionnaire completed by students (N=111) with the aim of gaining insight into their perceptions of different speech registers and of patient understanding. Excerpts of interviews were analyzed qualitatively to investigate students' communication strategies with respect to these technical terms. RESULTS Fewer than half of the terms were clarified. Students checked for simulated patients' understanding of the terms palliative and metastasis/to metastasize in 22-23% of the interviews. The term ambulatory was spontaneously explained in 75% of the interviews, hepatic and metastasis/to metastasize in 22-24%. Most provided explanations were in plain language; metastasis/to metastasize and ganglion/ganglionic were among terms most frequently explained in technical language. CONCLUSION A significant number of terms potentially unfamiliar and confusing to patients remained unclarified in training interviews conducted by senior medical students, even when they perceived the terms as technical. PRACTICE IMPLICATIONS This exploration may offer important insights for improving future physicians' skills.
Collapse
Affiliation(s)
- Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland.
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Raphael Bonvin
- Medical Education Unit, Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Alexandre Berney
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
44
|
Abioye Kuteyi EA, Bello IS, Olaleye TM, Ayeni IO, Amedi MI. Determinants of patient satisfaction with physician interaction: a cross-sectional survey at the Obafemi Awolowo University Health Centre, Ile-Ife, Nigeria. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2010.10874047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
45
|
Zucca A, Sanson-Fisher R, Waller A, Carey M. Patient-centred care: making cancer treatment centres accountable. Support Care Cancer 2014; 22:1989-97. [DOI: 10.1007/s00520-014-2221-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/14/2014] [Indexed: 11/29/2022]
|
46
|
Wagner JY, Wuensch A, Friess H, Berberat PO. Surgeon-patient communication in oncology. Eur J Cancer Care (Engl) 2014; 23:585-93. [PMID: 24393204 DOI: 10.1111/ecc.12177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2013] [Indexed: 11/29/2022]
Abstract
Little is known about the quality of post-operative communications following oncological surgery and the satisfaction of patients with the communication process. Thirty-eight patients who underwent surgery for primary gastrointestinal cancer were interviewed before being discharged from the hospital. The patients' recall of information concerning the surgery, histological diagnosis, post-operative therapy and treatment goal was assessed. The congruence between the information provided by the surgeons and that retained by the patients was evaluated. The information provided by the surgeons about the diagnosis, histology and post-operative therapy plan was correctly recalled by over 92%, 81% and 97% of the patients respectively. Only 70% of the patients correctly recalled information about the goal of the treatment. Moreover, patients receiving only palliative treatment showed less recall of information about the treatment goal than patients receiving curative treatment (33% versus 89%). The surgeons reported that only 35% of the patients left the hospital completely informed. Overall, the patients were highly satisfied with their communication with their surgeon, and the patients' recall of information was generally good. The information given by the surgeons was often incomplete, however. Our explorative analysis showed that the quality of communication was often worse for patients with a palliative treatment goal than for patients with a curative treatment goal.
Collapse
Affiliation(s)
- J Y Wagner
- Department of General Surgery, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | | | | | | |
Collapse
|
47
|
Tuck KK, Brod L, Nutt J, Fromme EK. Preferences of patients with Parkinson's disease for communication about advanced care planning. Am J Hosp Palliat Care 2013; 32:68-77. [PMID: 24052430 DOI: 10.1177/1049909113504241] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite shortening life, Parkinson's disease (PD) is often not considered "terminal." Uncertainty exists about when to discuss end-of-life planning. METHODS A survey was sent to patients with PD assessing attitudes toward the timing and initiation of discussions regarding their disease. Data were analyzed for patient preferences regarding communication. RESULTS Of 585 surveys, 267 were returned. Ninety-four percent of patients wanted prognosis and treatment information early. Half of the patients wanted to discuss advanced care documents early. Some wanted early discussions about end-of-life care planning (27%) or end-of-life care options such as hospice (21%). The majority felt shared responsibility for initiating discussions about life expectancy, advance care documents, and end-of-life care planning. CONCLUSIONS Preferences regarding end-of-life discussions vary. Consequently, neurologists should ask patients about their preferences for this information and offer discussion periodically.
Collapse
Affiliation(s)
- Keiran K Tuck
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Lissa Brod
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - John Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Erik K Fromme
- Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
48
|
Patient involvement in the decision-making process improves satisfaction and quality of life in postmastectomy breast reconstruction. J Surg Res 2013; 184:665-70. [DOI: 10.1016/j.jss.2013.04.057] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 04/15/2013] [Accepted: 04/24/2013] [Indexed: 11/20/2022]
|
49
|
Patient Anxiety Before and Immediately After Imaging-Guided Breast Biopsy Procedures: Impact of Radiologist-Patient Communication. J Am Coll Radiol 2013; 10:423-31. [DOI: 10.1016/j.jacr.2012.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 11/06/2012] [Indexed: 11/20/2022]
|
50
|
van Vliet L, Francke A, Tomson S, Plum N, van der Wall E, Bensing J. When cure is no option: how explicit and hopeful can information be given? A qualitative study in breast cancer. PATIENT EDUCATION AND COUNSELING 2013; 90:315-322. [PMID: 21555199 DOI: 10.1016/j.pec.2011.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/27/2011] [Accepted: 03/29/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate how oncologists can balance explicit with general and realistic with hopeful information when discussing various topics at the transition from curative to palliative care in breast cancer. METHODS Qualitative analysis of focus groups consisting of female breast cancer survivors and healthy women. RESULTS Perceptions of survivors and healthy women largely overlapped. Participants thought that oncologists can help patients regain a future perspective during this consultation. To achieve this, four themes seemed important: honest medical information, availability of continued support, hope has many faces, and space to choose. Moreover, participants stressed they would need time to let the message sink in before any further information was provided. CONCLUSION Participants thought that when confronted with this type of consultation they would need - more or less explicit - medical information and information regarding support. In order to maintain hope, knowledge about (treatment) possibilities is important, but also the certainty not to be abandoned by the hospital at a later stage of the disease and the confidence to remain able to make one's own decisions. PRACTICE IMPLICATIONS A life-limiting diagnosis may shatter patients' future perspective; however, this study provides suggestions for oncologists to create a new perspective.
Collapse
Affiliation(s)
- Liesbeth van Vliet
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|